Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–June 2018

November 15, 2018

A new report from NCHS presents selected estimates of health insurance coverage for the civilian noninstitutionalized U.S. population based on data from the 2018 National Health Interview Survey, along with comparable estimates from previous calendar years. Estimates for the first 6 months of 2018 are based on data for 39,112 persons.

Key Findings:

  • In the first 6 months of 2018, 28.5 million persons of all ages (8.8%) were uninsured at the time of interview—not significantly different from 2017, but 20.1 million fewer persons than in 2010.
  • In the first 6 months of 2018, among adults aged 18–64, 12.5% were uninsured at the time of interview, 20.0% had public coverage, and 69.2% had private health insurance coverage.
  • In the first 6 months of 2018, among children aged 0–17 years, 4.4% were uninsured, 43.4% had public coverage, and 53.6% had private health insurance coverage.
  • Among adults aged 18–64, 69.2% (137.1 million) were covered by private health insurance plans at the time of interview in the first 6 months of 2018. This includes 4% (7.9 million) covered by private health insurance plans obtained through the Health Insurance Marketplace or state-based exchanges.
  • The percentage of persons under age 65 with private health insurance enrolled in a high-deductible health plan increased, from 43.7% in 2017 to 46.0% in the first 6 months of 2018.
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High-deductible Health Plan Enrollment Among Adults Aged 18-64 With Employment-based Insurance Coverage

August 9, 2018

Questions for Robin Cohen, Ph.D. and Lead Author of “High-deductible Health Plan Enrollment Among Adults Aged 18-64 With Employment-based Insurance Coverage

Q: What made you decide to put together a report about high and low deductible health plans for adults with employment-based coverage?

RC: We decided to produce an analysis focusing on high-deductible health plans (HDHPs) after observing how enrollment in HDHPs has increased over the past decade. In addition, HDHP enrollment growth has been faster among those with employment-based coverage than among those with directly-purchased coverage, so it also made sense to highlight employment-based insurance plans in this study. This report examines differences in the demographic characteristics for those with employment-based coverage by plan type.    


Q: Was there a finding in your new report that really surprised you?

RC: It was the dramatic increase in high-deductible health plan (HDHP) enrollment in recent years that really surprised us. We hadn’t expected to see such a large jump, which was most notable among those with a health savings account (HSA). The percentage of adults aged 18 to 64 enrolled in an HDHP with an HSA more than quadrupled in the past decade from 4.2% to 18.9%.


Q: What differences or similarities did you see between or among various demographic groups in this analysis?

RC: Both the differences among age groups and the lack of variance by sex in this study’s findings are notable. Among adults aged 18 to 64 with employment-based coverage, there were no differences in the type of health insurance plan by sex. Enrollment in a high-deductible health plan with a health savings account was higher among adults aged 30 to 44 than those aged 18 to 29 and 45 to 64.


Q: What is the significance of having a health savings account and not having one when you have a high-deductible health insurance plan?

RC: A health savings account (HSA) allows pretax income to be saved to help pay for the higher costs associated with a high-deductible health plan (HDHP). However, this report did not examine the association of having an HDHP — coupled with an HSA — on service use and financial burden for medical care.

 

Q: Is it a choice for Americans to have a health savings account? Can anyone have one?

 

RC: A health savings account (HSA) must be coupled with a high-deductible health plan (HDHP), but not everyone enrolled in an HDHP has an HSA. High-deductible health plans with HSAs are offered to individuals both by employers and in the direct-purchase health insurance market.

Q: What would you say is the take-home message of this report?

 

RC: I think the real take-home message in this Data Brief is the role that education and income play in health insurance coverage with these types of high-deductible health plans (HDHPs). More highly educated and affluent adults were more likely to enroll in an HDHP with a health savings account (HSA) and less likely to enroll in a traditional plan or an HDHP without an HSA — than their less educated and less affluent counterparts. The National Health Interview Survey will continue to monitor different types of private health insurance, and the survey can be used to examine further differences according to plan type.

Q: Do you have trend data on high-deductible health plans going back further than 2007?

RC: No, we don’t have earlier than 2007 trend data on high-deductible health plans (HDHPs). The National Health Interview Survey began to collect data on enrollment in HDHPs starting in 2007.


Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2017

May 22, 2018

Questions for Robin Cohen, Ph.D., Health Statistician and Lead Author on “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2017

Q: What were some of the major findings in your full-year 2017 health insurance estimates?

RC: In 2017, 29.3 million persons were uninsured at the time of interview. This is 19.3 million fewer persons than in 2010. In 2017, 9.1% were uninsured, 36.2% had public coverage, and 62.6% had private coverage at the time of interview.


Q: What are the trends among race and ethnicity groups who were uninsured in 2017 and compared over time?

RC: In 2017, 27.2% of Hispanic, 14.1% of non-Hispanic black, 8.5% of non-Hispanic white, and 7.6% of non-Hispanic Asian adults aged 18–64 lacked health insurance coverage at the time of interview.

Significant decreases in the percentage of uninsured adults were observed from 2013 through 2017 for Hispanic, non-Hispanic black, non-Hispanic white, and non-Hispanic Asian adults.

Hispanic adults had the greatest percentage point decrease in the uninsured rate from 2013 (40.6%) through 2016 (25.0%). The observed increase among Hispanic adults between 2016 and 2017 (27.2%) was not significant.


Q: What does your data show this year for Americans who have high-deductible health insurance plans compared to previous years?

RC: In 2017, 43.7% of persons under age 65 with private coverage were enrolled in a high-deductible health plan (HDHP). Enrollment in HDHPs has increased 18.4 percentage points from 25.3% in 2010 to 43.7% in 2017. More recently, the percentage enrolled in an HDHP increased from 39.4% in 2016 to 43.7% in 2017.


Q: What do you see in state-level estimates of health insurance coverage this year?

RC: Among the 18 states presented in this report, there were no significant changes in the percentages of uninsured among persons aged 18–64 between 2016 and 2017.


Q: What is the take home message in this report?

RC: The take-home message from this report is found in the number of Americans who no longer lack health insurance. In 2017, 29.3 million (9.1%) persons of all ages were uninsured at the time of interview. This estimate is not significantly different from 2016, but there are 19.3 million fewer uninsured persons than in 2010.

 


Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–September 2017

February 22, 2018

A new NCHS report provides updated health insurance estimates from selected states using 2017 National Health Interview Survey data.

  • In the first 9 months of 2017, 28.9 million (9.0%) persons of all ages were uninsured at the time of interview—not significantly different from 2016, but 19.7 million fewer persons than in 2010.
  • In the first 9 months of 2017, among adults aged 18–64, 12.7% were uninsured at the time of interview, 19.5% had public coverage, and 69.3% had private health insurance coverage.
  • In the first 9 months of 2017, among children aged 0–17 years, 4.9% were uninsured, 41.9% had public coverage, and 54.6% had private health insurance coverage.
  • Among adults aged 18–64, 69.3% (136.5 million) were covered by private health insurance plans at the time of interview in the first 9 months of 2017. This includes 4.4% (8.6 million) covered by private health insurance plans obtained through the Health Insurance Marketplace or state-based exchanges.
  • The percentage of persons under age 65 with private health insurance enrolled in a high-deductible health plan (HDHP) increased, from 39.4% in 2016 to 43.2% in the first 9 months of 2017.

Problems Paying Medical Bills Among Persons Under Age 65: Early Release of Estimates From the National Health Interview Survey, 2011-June 2017

December 18, 2017

Questions for Robin Cohen, Ph.D., Health Statistician and Lead Author on “Problems Paying Medical Bills Among Persons Under Age 65: Early Release of Estimates From the National Health Interview Survey, 2011-June 2017

Q: What made you decide to focus on this special topic of Americans having problems paying medical bills?

RC: This report is the seventh in a series of reports looking at Americans having problems paying medical bills, and presents updated estimates using data from the first 6 months of 2017. Financial burden for medical care may put the entire family’s ability to pay medical bills — and its overall financial well-being — at risk. This report serves to continue to monitor the financial burden of health care in the United States.


Q: What do you think is the most significant finding in this study?

RC: Most noteworthy in this new report is the finding that since 2011, 13.2 million fewer persons under age 65 are in families having problems paying medical bills in the past 12 months.


Q: What kind of data do you have for persons who are specifically having problems paying for health insurance premiums and high deductibles in insurance plans?

RC: While this report does not specifically look at the details of persons’ health insurance plans, a report titled “High-deductible Health Plans and Financial Barriers to Medical Care: Early Release of Estimates From the National Health Interview Survey, 2016” was published in June 2017, and that report did take a look at some insurance plan details. The June report found that among privately insured adults aged 18-64 with employment-based coverage, those enrolled in a high-deductible health plan (HDHP) were more likely than those enrolled in a traditional plan, to forgo or delay medical care and to be in a family having problems paying medical bills. However, among privately insured adults aged 18-64 with directly purchased coverage, the pattern of results was different: there was no significant difference in financial barriers to health care according to the type of directly purchased plan.


Q: What are the trends among race and ethnicity groups who are having problems paying medical bills this year and compared over time?

RC: All race and ethnicity groups studied in this report saw decreases in the percentage of persons under age 65 who were in families having problems paying medical bills between 2011 and the first 6 months of 2017. Within each year from 2011 through 2017, non-Hispanic Asian persons were the least likely to be in families having problems paying medical bills.


Q: What type of demographics do you examine in this report, and what are those trends for those having problems paying medical bills this year and compared over time?

RC: This report provides trends for persons under age 65 who were in families having problems paying medical bills in the past 12 months from 2011 through the first 6 months of 2017 disaggregated by sex, age, race and ethnicity, health insurance coverage status, poverty status, and out-of-pocket medical expenses. Generally for all measures examined in the report, there has been a decrease in the percentage of persons in families having problems paying medical in the past 12 months between 2011 and the first six months of 2017. For example, among adults aged 18-64, the percentage who were in families having problems paying medical bills decreased from 20.6% in 2011 to 15.6% in the first 6 months of 2017.


Q: What is the take-home message of your report?

RC: I think the take-home message from this research is that among persons under age 65, one in six was in a family having problems paying medical bills in the first 6 months of 2017.


Health Insurance Coverage: Estimates from the National Health Interview Survey, January-June 2017

November 16, 2017

Emily P. Zammitti, M.P.H., Associate Service Fellow

Questions for Emily P. Zammitti, M.P.H., Associate Service Fellow and Lead Author on “Health Insurance Coverage: Estimates from the National Health Interview Survey, January-June 2017

Q: What is new in this report?

EZ: What’s new in this report is that we are putting out estimates based on data collected from January through June of 2017. For example, in the first 6 months of 2017, 9.0% of persons of all ages were uninsured, 36.4% had public coverage, and 62.6% had private coverage at the time of interview. For the first time using 2017 data, this report also presents state-level estimates for 11 states.


Q: What does your data show this year for Americans who have high-deductible health insurance plans compared to previous years?

 EZ: We’re seeing a continued climb in the percentage enrolled in high-deductible health insurance plans. In the first 6 months of 2017, 42.9% of privately insured persons under age 65 were enrolled in a high-deductible health plan, or an HDHP. Enrollment in HDHPs has increased from 25.3% in 2010, and more recently, has increased from 39.4% in 2016.  


Q: How has coverage through tax-advantaged health savings account insurance plans changed in 2017? 

EZ: This is another area where we’re seeing a statistically significant increase – Americans enrolled in tax-advantaged health savings account insurance plans. Among persons under age 65 who had private health insurance coverage, the percentage who had a high-deductible health plan with a health savings account, or a consumer-directed health plan, has more than doubled, from 7.7% in 2010 to 17.4% in the first 6 months of 2017. More recently, the percentage of those enrolled in a consumer-directed health plan increased from 15.5% in 2016 to 17.4%.


Q: Are a lot of Americans finding coverage through the Health Insurance Marketplaces?

EZ: This new report does offer updated statistics on the number of Americans finding coverage through the Health Insurance Marketplaces. Among persons under age 65, 65.4% (176.8 million people) were covered by private health insurance plans at the time of interview in the first 6 months of 2017. This includes 3.7% (10.1 million people) covered by private plans obtained through the Health Insurance Marketplace or state-based exchanges.


Q: What do you see in state-level estimates of health insurance coverage this year so far?

EZ: This report presents estimates of health insurance coverage in the first half of 2017 for 11 states: California, Florida, Georgia, Illinois, Michigan, New York, North Carolina, Ohio, Pennsylvania, Texas, and Virginia. Of these 11 states, in the first 6 months of 2017, the percentage of adults aged 18-64 who were uninsured was highest in Texas (25.1%), and lowest in New York (7.0%).  Despite variation in the uninsured estimates between 2016 and the first 6 months of 2017, none of the differences for any of the 11 selected states were significant.


Q: What is the take-home message from this report? 

EZ: I think the real take-home message from this report is found in the number of Americans who no longer lack health insurance. In the first 6 months of 2017, 28.8 million (9.0%) persons of all ages were uninsured at the time of interview. This estimate is not significantly different from 2016, but there are 19.8 million fewer uninsured persons than in 2010.


Health Insurance Coverage: Estimates from the National Health Interview Survey, January-March 2017

August 29, 2017

Questions for Robin Cohen, Ph.D., Health Statistician and Lead Author on “Health Insurance Coverage: Estimates from the National Health Interview Survey, January-March 2017

Q: What do you think is the most interesting demographic finding among your new study’s short-term trends – age, poverty status, or race and ethnicity?

RC:  There are many interesting short-term trends presented in this report, though I would like to highlight the three that I find most interesting. Among poor adults aged 18 to 64, the percentage who were uninsured decreased from 42.2% in 2010 to 22.6% in the first 3 months of 2017. A similar decrease in the percentage of uninsured was seen for near poor adults aged 18 to 64, from 43.0% in 2010 to 23.0% in the first 3 months of 2017. Hispanic adults aged 18 to 64 had the greatest percentage point decrease in the uninsured rate from 2013 (40.6%) through the first 3 months of 2017 (24.1%).


Q: What is the most compelling long-term trend in your new health insurance report?

RC: It is quite striking and encouraging to see long-term improvements in health insurance coverage for children in the United States. The percentage of children who were uninsured generally decreased from 13.9% in 1997 to 5.3% in the first 3 months of 2017. The observed increase in the percentage of uninsured children from 4.5% in 2015 to 5.3% in the first 3 months of 2017 was not statistically significant. From 1997 to 2012, the percentage of children with private coverage has generally decreased, and the percentage of children with public coverage has generally increased. However, more recently, the percentage of children with public or private coverage has leveled off.


Q: Why aren’t state estimates presented?

RC: State level estimates of insurance coverage are not presented in the Early Release report based on the first 3 months of data from the National Health Interview Survey due to considerations of sample size and precision. However, state level estimates are included in the Health Insurance Early Release report three times a year, with the report based on 6 months of data, 9 months of data and a full year of data.


Q: It looks as though coverage through high-deductible private health insurance plans continues to rise in 2017; what patterns do your estimates show this year compared to previous years? 

RC: In the first 3 months of 2017, 42.3% of persons under age 65 with private health insurance coverage were enrolled in a high-deductible health plan (HDHP), an increase from 39.4% in 2016. The percentage of persons enrolled in an HDHP increased 17 percentage points from 25.3% in 2010 to 42.3% in the first 3 months of 2017.


 

Q: What is the take home message from this report? 

RC: I think the real take-home message from this report is the long-term trend of remarkable improvement in the number of uninsured Americans. In the first 3 months of 2017, 28.1 (8.8%) million persons of all ages were uninsured at the time of interview —20.5 million fewer persons than in 2010 (16.0%). However, there was no significant change from the 2016 uninsured rate of 9.0% (28.6 million).